Taking Stock and Taking Steps: A Report from the Field after the First Year of Marketplace Consumer Assistance under the ACA

During the Patient Protection and Affordable Care Act’s first period of open enrollment October 2013 – March 2014, an estimated fourteen million people enrolled for health coverage through the new private insurance Marketplaces (8 million) and through Medicaid (6 million). To facilitate this substantial volume of enrollment and enrollment-related activities, approximately 4,400 Marketplace Assister Programs employing more than 28,000 full time-equivalent staff and volunteers served consumers nationwide. All Assister Programs were expected to help consumers understand their coverage options, apply for financial assistance, and enroll (see Appendix 1). Additional functions undertaken by many assisters included outreach and education; help with post-enrollment questions and problems; assistance with appeals of eligibility determinations; and help applying for other public benefits and services.

The emergence of Marketplace Assister Programs around the country is a significant health policy innovation. The majority of programs that were operational in 2013-14 needed to organize, launch and scale up quickly to be ready for the ACA’s first open enrollment period. Because so many programs were new or substantially expanded their scope during this first year, this period was also characterized by both the need and opportunity for widespread “learning by doing.” Several surveys conducted during or just at the close of 2013-14 Open Enrollment have already begun to assemble valuable data about: consumers’ experiences with assisters; assisters’ self-reported experiences; and best practices and lessons emerging from specific states or assister-related initiatives.[endnote 127351-11]

In addition, the Kaiser Family and Robert Wood Johnson Foundations convened a national Roundtable on consumer assistance in June of 2014. The purpose was to engage practitioners and other experts in a conversation about the establishment of new consumer assistance capacity in the rapidly-changing context of ACA implementation. Eighty leaders engaged in designing, directing, implementing, supporting, funding or coordinating with Assister Programs participated in the roundtable. Their discussion painted a detailed picture of consumer assistance from Year One and offered insights and guidance for ongoing implementation. This report summarizes the discussion, highlighting the challenges ahead and promising ideas and concrete steps that might be taken to strengthen consumer assistance.